Going Digital
By: Patricia Barry
AARP Bulletin
March 2008 – Vol. 49 No. 2
Page 22

You’re seeing a new medical specialist for the first time, but there’s no paperwork to fill out. Instead, this physician has everything about you at her fingertips – your medical history, your primary doctor’s notes, the results of your lab tests, the medications you’re taking. In seconds it’s all on her computer screen.

Or maybe a doctor is writing you a prescription for a newly diagnosed condition. But first he looks at the computerized records to be sure this drug works safely with other meds your taking, and to see if it’s covered by your insurance. Then, with a push of a button, he sends the typed script to the pharmacy. You needn’t worry that he doctor’s handwritten scrawl will mislead the pharmacist into giving you’re the wrong drug.

This is the future, but for some patients it has already arrived, as more doctors and hospital get “wired” by moving to electronic record keeping and paperless prescribing. Health information technology (HIT) – the bland umbrella term for this revolution in health care – promises vast benefits that go way beyond convenience. “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care,” President Bush said in 2004 when announcing a plan to get most Americans connected to electronic records by 2014.

Getting there means overcoming many obstacles, even though the medical community – from doctors and nurses to hospitals and insurers – recognizes HIT’s benefits. “HIT has huge potential, and in the next several years it will become much more universal than it is now,” says Don Goldmann, M.D., a professor at Harvard Medical School and vice president of the nonprofit Institute for Healthcare Improvement in Cambridge, Mass. “But we shouldn’t underestimate the complexity and cost.”

Above all, HIT raises big questions about patients’ privacy rights and sensitive information getting into the wrong hands. That issue, still far from being resolved, has for now stalled Congress’ efforts to speed up the process of implementing electronic records nationwide. As many as 98,000 Americans die each year as a result of medical errors, according to the Nation Academy of Sciences’ Institute of Medicine. Another 1.5 million people are harmed by errors in medications.

Even simple technology can help reduce errors – typing instead of handwriting a prescription, for example. More than 3,000 drugs have names that look or sound like others, according to the U.S. Pharmacopeia, the official standards – setting authority for medications.

But errors can be made by keystroke as well as by scrawl. And that’s why experts say a full “e-prescribing” system, especially when combined with e-records, offers greater safeguards. If a doctor accidentally types the wrong drug name when the patient’s diagnosis is already in the system, it can trigger an alert that the drug doesn’t fit the patient, says Allen Vaida, executive vice president of the Institute for Safe Medication Practices, a nonprofit in Huntingdon Valley, PA. “The software can give alerts for drug interactions and allergies and dosing. So if you happen to key in 200 mg when it should be 20, it says this does is out of range, so check it.”

Providing instant checks and feedback for prescribing doctors- and even giving them quick access to the latest medical research – is a major advance in improving the quality of care, says Steven Waldren, M.D., director of the Center for HIT at the American Academy of Family Physicians. “It’s like jet pilots. They know how to fly the plane, but every single time they get into a jet they have a checklist,” he says. HIT “can provide the same functionality, so that the right thing is done on the right patient at the right time – every time.”

In hospitals, another few new safeguard is a bar code embedded in the patient’s ID wristband that can access the medical record. To ensure correct treatment, nurses use a device like a supermarket scanner to check the bar code repeatedly.

Linda Mays, 59, a Board of Elections clerk in Delaware, Ohio, noticed this when she had surgery at her local hospital, Grady Memorial. “They scanned it when I left for the operation room, when I was in the holding room and just before I fell asleep,” she says. “It made me feel safe.” Storing a patient’s record in one file that several providers can access in seconds can prevent unnecessary tests and lots of wasted time, doctors say. Rebecca Fogel, M.D., a family physician now in Brooklyn, N.Y., had her first experience with e-records at a community clinic in Providence, R.I. “In a word,” she says, “it was fabulous.”

Making sense of a patient’s paper chart – a binder maybe two or three inches thick – and trying to decipher previous notes on faded pages has “reduced me to tears of frustration” on occasion, she says. “At best it’s maddening, but at worst it’s dangerous.” Searching an electronic record on her laptop is easy and reliable. “You keep clicking, and different screens pop up – the patient’s meds list, problems list, allergies, test results, past surgeries,” she says. “It’s all there.”

Another plus: If a patient calls at night or on the weekend, the doctor can access the medical record on a home computer instead of relying on memory. And the system can instantly generate reminders of when patients are due for test, checkups or shots. “It just enhances what you can do for the patient,” Fogel says. But some systems are more reliable than others, and converting to electronic records can be complicated and expensive. A basic system for doctors’ offices can cost $20,000 to $80,000. Still, the number of U.S. doctors in small practices using e-records is growing, reaching about 28% in 2007. Recent bills in Congress would offer doctors grants, loans and other incentives to go digital.

The legislation also sets the stage for achieving “interoperability” – the buzzword for enabling different digital systems to share records seamlessly. But the big challenge is privacy, a concern of patients, doctors and policymakers alike. People need to feel confident that their medical records remain private, or they won’t want them in an electronic system, says Deborah Peel, M.D., a psychiatrist from Austin, Texas, and founder of the Patient Privacy Rights nonprofit group. “We don’t have to get rid of privacy to have health IT – in fact, we can have far more exquisite privacy protection with technology than we can with paper,” she says. “But in this world that’s the Wild West, where anyone with a database feels free to use and sell your records, we need a safe place to keep records that we control.” That place could be a national health bank “with state-of-the-art Fort Knox security,” she says.

New legislation, Peel says, is needed especially to protect personal health records (PHRs), into which patients can import their own medical records. “A PHR is not an official health record, so no law covers them,” she says. “That makes them a perfect setup for data mining.” Patients should have a legal right to control all their medical information, Peel argues, with penalties for those who breach it. But that’s a political sticking point in Washington. Some people, like Peel, want privacy rules enacted first. Others want to let the market resolve the issue. Still others, in the face of congressional gridlock, favor legislation that would set up an independent body to develop regulations outside Congress.

“That’s the most pragmatic approach,” says John Rother, AARP policy director. “We need to both protect privacy and advance HIT as fast as wecan.”